918. Pilot Surveillance for Carbapenemase Gene-positive Organisms Among Hospitalized Solid Organ Transplant Recipients. (31st December 2020)

• Record Type: Journal Article
• Authors: Chan, June L; Nazarian, Elizabeth; Musser, Kimberlee A; Fung, Monica; Doernberg, Sarah B; Pouch, Stephanie M; Pouch, Stephanie M; Leekha, Surbhi; Anesi, Judith A; Kodiyanplakkal, Rosy Priya; Turbett, Sarah; Walters, Maroya Spalding; Epstein, Lauren; Epstein, Lauren
• Is Part Of: Open forum infectious diseases. Volume 7:Number 1(2020) Supplement
• Page Start: S493
• Page End: S494
• Publication Date: 2020-12-31
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa439.1106
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Carbapenemase gene-positive organisms (CPOs) are associated with infections with high mortality rates and have the potential to facilitate epidemic spread of carbapenem resistance. Passive reporting to CDC identified CPOs among organ transplant recipients, potentially representing an emerging reservoir for spread. We aimed to determine the prevalence of CPOs in hospital units where solid organ transplant (SOT) recipients receive care in order to inform public health action to prevent transmission. Methods: All healthcare facilities identified one medical unit where SOT recipients received inpatient care and conducted point prevalence surveys (PPS) of all consenting patients on 1-2 designated calendar days. We used the Cepheid Xpert ® Carba-R assay to identify carbapenemase genes ( bla KPC, bla NDM, bla VIM, bla IMP, bla OXA-48 ) from rectal swabs; carbapenemase-positive swabs were cultured for organisms. All laboratory testing was conducted at the Wadsworth Center, part of CDC's Antibiotic Resistance Laboratory Network. Results: Five participating hospitals performed nine PPS from September 2019 through June 2020. In total, 154 patients were screened and 92 (60%) were SOT recipients (Table). The most common transplanted organs were kidney (44, 48%) and liver (39, 42%). Carbapenemase genes were detected among 5 (5%) SOT recipients, all from a single healthcare facility; 4 (80%) were bla KPC and 1 (20%) was bla NDM . Of the positive specimens cultured, bla KPC was carried by Enterobacter cloacae complex (ECC), Klebsiella pneumoniae, and Klebsiella oxytoca and bla NDM was carried by K. oxytoca ; bla KPC was carried by both ECC and K. pneumoniae in a single individual. For SOT patients with CPOs, the median interval from transplantation to swab collection was 108 days (range: 12 to 323). CPOs were only detected in 1 (2%) of 62 non-transplant patients. TABLE Characteristics of Carbapenemase Gene-positive Organism (CPO) Pilot Surveillance Participants Conclusion: Among participating facilities, most did not identify CPOs among patients admitted to transplant units. These findings represent a small number of patients and facilities; additional PPS in areas with varied CPO epidemiology are needed to understand whether SOT recipients should be routinely screened for CPOs. Disclosures: All Authors : No reported disclosures